Project Summary/Abstract. The objective of this research is to investigate the influence of developmental factors that may influence the outcome of a vetted, standard of care voice therapy for children with common, benign phonotraumatic lesions, vocal fold nodules. Specific Aim 1 will investigate the influence of children's cognitive developmental abilities on their learning response in voice therapy, in terms of their acquisition of a therapeutic phonation pattern, ?resonant voice,? in the vetted therapy program, Adventures in Voice (AIV). Specific Aim 2 will investigate the influence of children's physical development stage on their biological response to Adventures in Voice, in terms of reduction in nodule size, as a function of baseline estimates of vocal fold tissue elasticity, which is known to vary with age. Specific Aim 3 is exploratory, and assesses a fuller, integrated causal model of vocal and laryngeal improvements with voice therapy for nodules, as a function of cognitive and physical maturation. Specific Aim 3 will also address at an exploratory level other factors that may contribute to therapy outcome such as medical co-morbidities, reported child compliance with therapy, and reported parental involvement with therapy. We will use a longitudinal observational study design in a single cohort across aims, incorporating technologies that are novel for such studies but well vetted in bench science, including high- speed video imaging and videostroboscopy with laser projection, this latter to obtain precise measures of nodule size pre and post therapy. These technologies will be integrated with more traditional ones including acoustic and perceptual evaluation of voice and larynx. The long-term goal is to refine and advance intervention models for millions of children whose quality of life is affected by these benign vocal fold lesions. Results will inform emerging behavioral strategies in voice therapy for the millions of children who are affected by these conditions, and who currently suffer substantial health- related consequences as a result.